Judicial outcome and follow up of abused child protection acts in a pediatric emergency department: 12-year experience in a third level pediatric hospital

Abstract

Background Italian laws allow the protection of a child who is suspected to be a victim of abuse through a procedure that can be put in motion by the attending physician in any Emergency Department (article nr. 403 Civil Code) with a temporarily suspension of parental authority. This study aims at evaluating both the appropriateness of the activation of the protection procedure by ED doctors in cases of suspected child abuse in terms of judicial confirmation and how it impacts children in the long-term. Methods We selected cases in which the procedure was activated due to suspected child abuse. The children were admitted to the ED of a tertiary children hospital from 2006 to 2018. We then reviewed the medical charts and collected data from the social services through a questionnaire concerning the long-term outcomes . Results Twenty-eight patients were included (75% females, mean age 13.8 years). In 90% of cases the activation of the procedure in the ED was followed by a Court confirmation. Evaluation of long term outcome was possible in 22 cases. Among them, a positive social outcome was achieved in 15 cases (68.2%). The remaining abandoned the program or had critical reintegration in the family. Eighteen percent of patients developed major issues such as aberrant behaviours, substance abuse or psychiatric disorders. Conclusions This report identifies a good ability of ED doctors in the activation of an emergency procedure to protect the child. Overall, the social outcome was good for nearly 70% of the patients, highlighting the importance of activation of social support programs for child abuse.

Social Representations of nurses on the approach to children and adolescents who are victims of violence

“…From this perspective, apprehension of the convergences and divergences in the nurses’ approach to children and adolescents who are victims of violence raises the need to understand the social representations of the nurses’ performance in different health care settings. The nurses’ role in primary health care is marked by the bond with the communities, which, on the one hand, favors the identification of situations of violence and, on the other hand, causes fears and insecurities in the face of the cases ( 17 ) ; in the hospital service, nurses are in an emergency context with difficulties in correctly identifying and reporting abuse situations with children and adolescents ( 18 ) .…”